Retrospective analysis of risk factors for development of biliary fistula after liver cyst hydatid surgery

Abstract

Aim: Hepatic hydatidosis is common parasitosis in Turkey and caused by Echinococcus granulosus. Biliary fistula is the most common complication after liver hydatid cyst surgery. The aim of this study was to investigate an appropriate treatment strategy for patients whose biliary fistula might develop, by revealing variables that affect biliary fistula.Methods: A total of 118 patients who underwent liver hydatid cyst surgery were included in this study. The following variables were analyzed between patients with biliary fistula (group 2) and without fistula (group 1): Age, gender, hematologic and liver function tests, and features of the cysts (type, cyst size, number, and localization).Results: Cystobiliary fistula was detected in 19 (16%) of 118 patients. In-group 2, cyst size, white blood cell, alkaline phosphatase and g-Glutamyl transpeptidase levels were higher than group 1 on univariate analysis (p=0.03, p=0.008, p=0.04 and p=0.001, respectively). In the multivariate model, only cyst diameter remained as an independent predictor (odds ratio 0.03, 95% confidence interval 0.002 to 0.06; p=0.03) On the receiver operating characteristic curve, the 100% sensitive, 100% specific, and optimal cutoffs of the cyst diameter were 7.5 cm, 4.0 cm and14.6 cm, respectively (The area under the receiver operator characteristic curve was 0.67). Conclusion: Preoperative cyst size is a valuable parameter for predicting biliary fistula. Our study suggests that cyst size greater than 7.5 cm is a risk factor for biliary fistula.